Perianal abscess following doppler-guided transanal hemorrhoidal dearterialization

The doppler-guided transanal hemorrhoidal dearterialization (DGTHD) is a well-established and validated minimally invasive procedure for the treatment of symptomatic hemorrhoids. As compared to the excisional technique, DG-THD has the advantage of being associated with less post-operative pain and do not compromise the anatomy or the physiology of the anal canal. Our objectif is to describe the first case of perianal abscess following DG-THD. We report perianal abscess in a previously healthy 32year-old male patient, who underwent DG-THD for grade II hemorrhoids, as an outpatient procedure. One week later, the patient complained of persistent pain in the right iliac fossa and hypogastrium. CT-scan showed a peri-rectal fluid collection with gas bubbles and peripheral enhancement. MRI was obtained after first attempt of elective drainage, showing increase of the collection diameter without any fistula, which prompted a surgical exploration and drainage. Multi sensitive E. coli was found on culture. Postoperative recovery was slow but favourable. To the best of our knowledge, no previous report of perianal abscess following DGTHD has been described in the literature, which we believe in our case to be of haematogenous origin. Figure 1: Sagittal T2-weighted pelvic magnetic resonance imaging shows perianal abscess